Head and Neck Cancers
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Head and neck cancers are malignancies arising in the upper aerodigestive tract (this includes: lip, tongue, salivary glands, mouth, oropharynx, nasopharynx, hypopharynx, nasal cavity, and larynx). Laryngeal (voice-box) cancer is the most frequent type, accounting for about a quarter of head and neck cancers.

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Laryngeal Cancer
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Molecular Biology of Head and Neck Cancers
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Latest Research Publications

Head and Neck Cacer Resources (16 links)

Latest Research Publications

This list of publications is regularly updated (Source: PubMed).

Prgomet D, Bacić A, Prstacić R, Janjanin S
Complications of endoscopic CO2 laser surgery for laryngeal cancer and concepts of their management.
Coll Antropol. 2013; 37(4):1373-8 [PubMed] Related Publications
Endoscopic CO2 laser surgery (ELS) is a widely accepted treatment modality for early laryngeal cancer. Commonly reported advantages of ELS are good oncologic results with low incidence of complications. Although less common if compared with open procedures, complications following ELS can be very serious, even with lethal outcome. They can range from intraoperative endotracheal tube fire accidents to early and late postoperative sequels that require intensive medical treatment, blood transfusion, or revision surgery. We present our institutional experience, discuss the possible complications of ELS for laryngeal cancer, and outline the concepts of their treatment, with comprehensive literature review. Complications are more frequent following the treatment of supraglottic as compared to glottic cancer. If compared with open surgery, ELS for laryngeal cancer is associated with a lower incidence of complications. Every surgeon performing ELS should comply with particular strategies to avoid complications in the first place, and have a clear concept of their management if they occur.

Related: Cancer of the Larynx Laryngeal Cancer - Molecular Biology

Radfar L, Holt T, Masood F
Case report of an oral fibroma occurring in a patient with familial multiple lipomas.
Tex Dent J. 2013; 130(12):1195-9 [PubMed] Related Publications
A wide variety of lesions may manifest in the oral soft tissues that could be confusing and challenging for the clinicians. These lesions could be as simple as trauma-induced ulcers that need about 2 weeks to heal, to a more complicated situation such as oral cancer. The key points in developing diagnosis and a possible treatment plan may include a comprehensive oral examination, simple understanding of normal oral tissue features, and knowledge of common oral lesions. This will help in the development of a differential diagnosis of the oral lesions/masses based on the risk factors in that particular patient. In this case report, we present a simple oral mass in a patient who had an oral fibroma and lipomas in other areas.

Related: Oral Cancer Skin Cancer

Wikman A, Johar A, Lagergren P
Presence of symptom clusters in surgically treated patients with esophageal cancer: implications for survival.
Cancer. 2014; 120(2):286-93 [PubMed] Related Publications
BACKGROUND: It is not known whether symptoms cluster together after esophageal cancer surgery or whether such symptom clusters are associated with survival in patients with esophageal cancer who are treated surgically.
METHODS: Data from a prospective Swedish nationwide cohort study of surgically treated patients with esophageal cancer recruited between 2001 and 2005 were used. General and esophageal cancer-specific symptoms were assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 quality of life questionnaire and the QLQ-OES18 module at 6 months after surgery. Associations between symptom clusters and survival were analyzed using Cox proportional hazards models, providing hazards ratios with 95% confidence intervals, adjusted for other known prognostic factors.
RESULTS: Among 402 patients reporting symptoms 6 months after surgery, 3 symptom clusters were identified. The first symptom cluster (“fatigue/pain”) was characterized by symptoms of pain, fatigue, insomnia, and dyspnea and was present in 30% of patients. The second symptom cluster (“reflux/cough”) was characterized by symptoms of dry mouth, problems with taste, coughing, and reflux and was present in 27% of patients. The third symptom cluster (“eating difficulties”) was characterized by appetite loss, dysphagia, eating difficulties, and nausea/vomiting and was present in 28% of patients. The presence of the reflux/cough and eating difficulties symptom clusters was associated with a statistically significantly increased risk of mortality (adjusted hazards ratio, 1.43 [95% confidence interval, 1.08-1.89] and adjusted HR, 1.41 [95% confidence interval, 1.06-1.87], respectively).
CONCLUSIONS: Symptoms experienced by surgically treated patients with esophageal cancer appear to cluster together, and the presence of these symptom clusters appears to have strong prognostic value.

Related: Cancer of the Esophagus Esophageal Cancer

Stangierski A, Wolinski K, Martin K, et al.
Core needle biopsy of thyroid nodules - evaluation of diagnostic utility and pain experience.
Neuro Endocrinol Lett. 2013; 34(8):798-801 [PubMed] Related Publications
OBJECTIVE: A crucial problem in the non-operative diagnosis of thyroid nodules is the significant amount of non-diagnostic biopsies. This is a challenge for practicing endocrinologists especially when the results of the repeated biopsies remain non-diagnostic. The lack of a concrete preoperative diagnosis may result in unnecessary thyroidectomies in patients. Alternatively, it may also lead to the delayed diagnosis of cancer. One method of biopsy specimen acquisition that could potentially increase the diagnostic accuracy of thyroid biopsies is the application of core-needles. The aim of the study was to compare the diagnostic value and patient tolerability of core-needle aspiration biopsies (CNAB) with fine-needle aspiration biopsies (FNAB).
PATIENTS AND METHODS: The study included patients with thyroid nodular goiter in whom previous conventional FNAB yielded non-diagnostic results. CNABs were performed using 22G core-needles. The control group consisted of patients undergoing conventional FNAB with 25G fine-needles. Pain during core-needle biopsies of thyroid nodules was assessed using the 10-point visual analog scale.
RESULTS: There were a total of 30 lesions in 26 patients undergoing CNAB (22 women, 4 men, mean age 48.3) and a total of 59 lesions in 40 patients undergoing FNAB (34 women, 6 men, mean age 57.3). 56.6% of CNABs and 50.8% of FNABs were diagnostic (p=0.60). When assessing pain via the visual analog scale, the median score for biopsies performed with core-needles was four. 60.0% of patients considered the pain of core-needle aspiration biopsies to be similar to the pain experienced during the previous conventional fine-needle aspiration biopsies, while 40% of patients claimed that the pain was more intense.
CONCLUSIONS: CNAB did not prove to be superior to FNAB. Despite the larger needle gauge used during core-needle biopsies, the patients' tolerability was comparable to conventional fine-needle biopsies.

Related: Thyroid Cancer

Baschnagel AM, Williams L, Hanna A, et al.
c-Met expression is a marker of poor prognosis in patients with locally advanced head and neck squamous cell carcinoma treated with chemoradiation.
Int J Radiat Oncol Biol Phys. 2014; 88(3):701-7 [PubMed] Related Publications
PURPOSE: To examine the prognostic significance of c-Met expression in relation to p16 and epidermal growth factor receptor (EGFR) in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) treated with definitive concurrent chemoradiation.
METHODS AND MATERIALS: Archival tissue from 107 HNSCC patients treated with chemoradiation was retrieved, and a tissue microarray was assembled. Immunohistochemical staining of c-Met, p16, and EGFR was performed. c-Met expression was correlated with p16, EGFR, clinical characteristics, and clinical endpoints including locoregional control (LRC), distant metastasis (DM), disease-free survival (DFS), and overall survival (OS).
RESULTS: Fifty-one percent of patients were positive for p16, and 53% were positive for EGFR. Both p16-negative (P≤.001) and EGFR-positive (P=.019) status predicted for worse DFS. Ninety-three percent of patients stained positive for c-Met. Patients were divided into low (0, 1, or 2+ intensity) or high (3+ intensity) c-Met expression. On univariate analysis, high c-Met expression predicted for worse LRC (hazard ratio [HR] 2.27; 95% CI, 1.08-4.77; P=.031), DM (HR 4.41; 95% CI, 1.56-12.45; P=.005), DFS (HR 3.00; 95% CI, 1.68-5.38; P<.001), and OS (HR 4.35; 95% CI, 2.13-8.88; P<.001). On multivariate analysis, after adjustment for site, T stage, smoking history, and EGFR status, only high c-Met expression (P=.011) and negative p16 status (P=.003) predicted for worse DFS. High c-Met expression was predictive of worse DFS in both EGFR-positive (P=.032) and -negative (P=.008) patients. In the p16-negative patients, those with high c-Met expression had worse DFS (P=.036) than did those with low c-Met expression. c-Met expression was not associated with any outcome in the p16-positive patients.
CONCLUSIONS: c-Met is expressed in the majority of locally advanced HNSCC cases, and high c-Met expression predicts for worse clinical outcomes. High c-Met expression predicted for worse DFS in p16-negative patients but not in p16-positive patients. c-Met predicted for worse outcome regardless of EGFR status.

Bayer C, Liebhardt ME, Schmid TE, et al.
Validation of heat shock protein 70 as a tumor-specific biomarker for monitoring the outcome of radiation therapy in tumor mouse models.
Int J Radiat Oncol Biol Phys. 2014; 88(3):694-700 [PubMed] Related Publications
PURPOSE: Tumor cells, in contrast to normal cells, frequently overexpress heat shock protein 70 (Hsp70) in the cytosol, present it on their cell surface, and actively release it. Therefore, soluble Hsp70 (sHsp70) was investigated as a potential tumor biomarker for monitoring the outcome of radiation therapy.
METHODS AND MATERIALS: Plasma from mice bearing membrane Hsp70 (mHsp70)-positive FaDu human squamous cell carcinoma of the head and neck and spontaneous pancreatic ductal adenocarcinoma (PDAC) was investigated. A cohort of mice with FaDu tumors (0.32 cm(3)) was irradiated with 30 Gy, and plasma was collected 24 hours after irradiation, after the tumors had shrunk to 50% of their starting volume and after complete remission. sHsp70 levels in the plasma were quantified by enzyme-linked immunosorbent assay.
RESULTS: sHsp70 levels were significantly higher in the blood of tumor-bearing mice than that of control animals. A correlation between increasing sHsp70 plasma levels and tumor volume in the range of 0.01 cm(3) to 0.66 cm(3) was observed. Radiation-induced regression of the tumors was associated with significantly decreased sHsp70 levels, which returned to the level of control animals after complete remission.
CONCLUSION: We propose sHsp70 as an innovative biomarker for detecting tumors and for monitoring the clinical outcome of radiation therapy in cancer patients.

Related: Cancer of the Pancreas Pancreatic Cancer

Michaelson EM, Chen YH, Silver B, et al.
Thyroid malignancies in survivors of Hodgkin lymphoma.
Int J Radiat Oncol Biol Phys. 2014; 88(3):636-41 [PubMed] Related Publications
PURPOSE: To quantify the incidence of thyroid cancer after Hodgkin lymphoma (HL) and determine disease characteristics, risk factors, and treatment outcomes.
METHODS AND MATERIALS: Thyroid cancer cases were retrospectively identified from a multi-institutional database of 1981 HL patients treated between 1969 and 2008. Thyroid cancer risk factors were evaluated by a Poisson regression model.
RESULTS: With a median follow-up duration of 14.3 years (range, 0-41.2 years), 28 patients (1.4%) developed a thyroid malignancy. The overall incidence rate (expressed as the number of cases per 10,000 person-years) and 10-year cumulative incidence of thyroid cancer were 9.6 and 0.26%, respectively. There were no observed cases of thyroid malignancy in patients who received neck irradiation for HL after age 35 years. Age <20 years at HL diagnosis and female sex were significantly associated with thyroid cancer. The incidence rates of females aged <20 at HL diagnosis in the first 10 years, ≥10 years, ≥15 years, and ≥20 years after treatment were 5, 31, 61, and 75 cases per 10,000 person-years of follow-up, respectively. At a median follow-up of 3.5 years after the thyroid cancer diagnosis, 26 patients (93%) were alive without disease, 1 (4%) was alive with metastatic disease, and 1 (4%) died of metastatic disease, at 6 and 3.6 years after the thyroid cancer diagnosis, respectively.
CONCLUSIONS: Although HL survivors have an increased risk for thyroid cancer, the overall incidence is low. Routine thyroid cancer screening may benefit females treated at a young age and ≥10 years from HL treatment owing to their higher risk, which increases over time.

Related: Bleomycin Dacarbazine Doxorubicin Hodgkin's Lymphoma Childhood Hodgkin's Lymphoma Hodgkin Lymphoma - Molecular Biology Procarbazine Thyroid Cancer Vinblastine Vincristine Gemcitabine

Stenmark MH, McHugh JB, Schipper M, et al.
Nonendemic HPV-positive nasopharyngeal carcinoma: association with poor prognosis.
Int J Radiat Oncol Biol Phys. 2014; 88(3):580-8 [PubMed] Related Publications
PURPOSE: To investigate the relationship between human papillomavirus (HPV) and Epstein-Barr virus (EBV) in nonendemic nasopharyngeal carcinoma (NPC) and assess the prognostic implications of viral status.
METHODS AND MATERIALS: Paraffin-embedded tumor specimens from 62 patients with primary NPC diagnosed between 1985 and 2011 were analyzed for EBV and high-risk HPV. EBV status was determined by the use of in situ hybridization for EBV encoded RNA. HPV status was assessed with p16 immunohistochemistry and multiplex polymerase chain reaction MassArray for determination of HPV type. Proportional hazards models were used to compare the risk of death among patients as stratified by viral status.
RESULTS: Of 61 evaluable tumors, 26 (43%) were EBV-positive/HPV-negative, 18 (30%) were HPV-positive/EBV-negative, and 17 (28%) were EBV/HPV-negative. EBV and HPV infection was mutually exclusive. HPV positivity was significantly correlated with World Health Organization grade 2 tumors, older age, and smoking (all P<.001). The racial distribution of the study population was 74% white, 15% African American, and 11% Asian/Middle Eastern. Among HPV-positive patients, 94% were white. At a median follow-up time of 7 years, HPV-positive and EBV/HPV-negative tumors exhibited worse outcomes than did EBV-positive tumors, including decreased overall survival (hazard ratio [HR] 2.98, P=.01; and HR 3.89, P=.002), progression-free survival (HR 2.55, P=.02; and HR 4.04, P<.001), and locoregional control (HR 4.01, P=.03; and HR 6.87, P=.001).
CONCLUSION: In our Midwestern population, high-risk HPV infection may play an etiologic role in the development of nonendemic, EBV-negative NPC. Compared with EBV-positive NPC, HPV-positive and EBV/HPV-negative NPC are associated with worse outcomes. A larger confirmatory study is needed to validate these findings.

Related: Nasopharyngeal Cancer

Macann A, Fua T, Milross CG, et al.
Phase 3 trial of domiciliary humidification to mitigate acute mucosal toxicity during radiation therapy for head-and-neck cancer: first report of Trans Tasman Radiation Oncology Group (TROG) 07.03 RadioHUM study.
Int J Radiat Oncol Biol Phys. 2014; 88(3):572-9 [PubMed] Related Publications
PURPOSE: To assess the impact of domicile-based humidification on symptom burden during radiation therapy (RT) for head-and-neck (H&N) cancer.
METHODS AND MATERIALS: From June 2007 through June 2011, 210 patients with H&N cancer receiving RT were randomized to either a control arm or to receive humidification using the Fisher & Paykel Healthcare MR880 humidifier. Humidification commenced on day 1 of RT and continued until Common Terminology Criteria for Adverse Events (CTCAE), version 3.0, clinical mucositis (CMuc) grade ≤1 occurred. Forty-three patients (42%) met a defined benchmark for humidification compliance and contributed to per protocol (PP) analysis. Acute toxicities, hospitalizations, and feeding tube events were recorded prospectively. The McMaster University Head and Neck Radiotherapy Questionnaire (HNRQ) was used for patient-reported outcomes. The primary endpoint was area under the curve (AUC) for CMuc grade ≥2.
RESULTS: There were no significant differences in AUC for CMuc ≥2 between the 2 arms. Humidification patients had significantly fewer days in hospital (P=.017). In compliant PP patients, the AUC for CTCAE functional mucositis score (FMuc) ≥2 was significantly reduced (P=.009), and the proportion who never required a feeding tube was significantly greater (P=.04). HNRQ PP analysis estimates also in the direction favoring humidification with less symptom severity, although differences at most time points did not reach significance.
CONCLUSIONS: TROG 07.03 has provided efficacy signals consistent with a role for humidification in reducing symptom burden from mucositis, but the influence of humidification compliance on the results moderates recommendations regarding its practical utility.

Sokouti M, Montazeri V, Fakhrjou A, et al.
Thyroid cancer, clinical and hystopathological study on patients under 25 years in Tabriz, Iran (2000-2012).
Pak J Biol Sci. 2013; 16(24):2003-8 [PubMed] Related Publications
Thyroid cancer comprises a broad spectrum of diseases with variable prognoses. The aim of this study was to assess thyroid cancer in young population using the surveillance, epidemiology and end results database and whether radioactive fallout from the Chernobyl accident in 1986 influenced thyroid cancer incidence among children and adolescents in Tabriz, Iran. Patients aged 5-25 in Tabriz from April 2000 to April 2012 were studied. Using the surveillance and end results database, the study examined the overall incidence of thyroid cancer with variations based on tumor pathology, size and stage, as well as the current surgical therapy of thyroid carcinoma. This study demonstrated a positive correlation between thyroid carcinoma tumor size and stage of disease. Mortality rates were higher among men than women. Recurrence rates are also higher in men. Compared with women, men have greater likelihood ofloco regional lymph node involvement and more than twice the rate of distant metastases. Operative treatment for thyroid cancer also has shifted with Radical dissection+Total thyroidectomy replacing partial thyroidectomy as the most common surgical procedure. Our data indicate that the increasing incidence of thyroid cancer cannot be accounted for fully by an increased detection of small neoplasms. This study show the increasing in thyroid cancer incidence related to exposure to radiation from the Chernobyl accident.

Related: Thyroid Cancer

Tsimplaki E, Argyri E, Xesfyngi D, et al.
Prevalence and expression of human papillomavirus in 53 patients with oral tongue squamous cell carcinoma.
Anticancer Res. 2014; 34(2):1021-5 [PubMed] Related Publications
BACKGROUND/AIM: Human papillomavirus (HPV) infection has been considered a potential risk factor for the development of oral tongue squamous cell carcinoma (SCC). The purpose of the present study was to investigate HPV infection and high-risk HPV E6/E7 mRNA expression in SCC of the oral tongue in 53 Greek patients.
MATERIALS AND METHODS: Fifty-three biopsies were collected from patients with SCC of the oral tongue and tested for HPV DNA and E6/E7 mRNA expression.
RESULTS: The overall prevalence of HPV DNA was 11.3% (6/53), while high-risk HPV DNA was found in 7.5% (4/53) of SCC of the oral tongue. E6/E7 mRNA expression was observed in 9.4% (5/53) samples examined. HPV 16 was the commonest genotype identified by both DNA and RNA assays. A total of 28.3% (15/53) of the patients were non-smokers and non-drinkers. HPV infection was strongly associated with abstinence from tobacco and alcohol (p=0.013).
CONCLUSION: The presence of high-risk HPV E6/E7 mRNA expression suggests that HPV may be implicated in the pathogenesis of SCC of the oral tongue.

Seccia V, Muscatello L, Dallan I, et al.
Electrochemotherapy and its controversial results in patients with head and neck cancer.
Anticancer Res. 2014; 34(2):967-72 [PubMed] Related Publications
BACKGROUND: Electrochemotherapy (ECT) is proposed as an innovative treatment for cutaneous and subcutaneous primary and secondary malignancies. Its actual application is limited to palliative treatment but recent experience predisposes for its utilization as neoadjuvant and first-line treatment. We explored the clinical application of ECT in a population of patients with head and neck cancer and we critically analyzed our results.
PATIENTS AND METHODS: Nine patients (four females; mean age=62.7 years) with recurrent or persistent squamous cell cancer in the head and neck area were treated with electrochemotherapy (ECT), with the aim of controlling local neoplastic growth and diminish local symptoms (pain, bleeding).
RESULTS: Our results in terms of local control and impact on quality of life were evaluated: among 14 lesions assessable for the study, 6/14 lesions exhibited a partial response, 4/14 a complete response, and in four cases we observed progression of the disease.
CONCLUSION: Our personal experience in a heterogeneous, small group of patients with head and neck cancer gave controversial results, with disputable advantages in terms of quality of life improvement. We believe that the critical aspects of ECT in patients with head and neck cancer need to be further analyzed in order to better focus on the role of ECT for head and neck cancer.

Related: Bleomycin

Matsumoto A, Ishibashi Y, Urashima M, et al.
High UBCH10 protein expression as a marker of poor prognosis in esophageal squamous cell carcinoma.
Anticancer Res. 2014; 34(2):955-61 [PubMed] Related Publications
BACKGROUND/AIM: Ubiquitin-conjugating enzyme H10 (UBCH10) is required in the cell-cycle transition from metaphase to anaphase. Therefore, we investigated whether its expression level in cancerous esophageal lesions affected prognosis of patients with esophageal squamous-cell carcinoma.
MATERIALS AND METHODS: Paraffin-embedded tissue samples from 121 patients with esophageal squamous cell carcinoma were stained with antibody to UBCH10 for immunohistochemical analysis.
RESULTS: UBCH10 was expressed in cancerous and dysplastic lesions, but not in normal tissue. Patients were grouped according to expression: High (N=33) or low (N=88), depending on the staining pattern. There were significant differences between the groups in terms of invasion into lymphatic vessels, number of metastatic lymph nodes, TNM classification, and stages, as well as in survival: the 50% survival rate in the high expression group was 2.3 years, whereas it was 9.9 years for the low-expression group (p<0.0001). Even with multivariate adjusting for stage 0 to stage IV using the Cox proportional hazard model, patients belonging to the high-expression group had a poor prognosis (Hazard ratio=2.5; 95% Confidence Interval=1.3-4.5; p=0.004).
CONCLUSION: High protein expression of UBCH10 is a marker of poor prognosis in esophageal squamous cell carcinoma.

Related: Cancer of the Esophagus Esophageal Cancer

Sohda M, Honjyo H, Hara K, et al.
L-[3-18F]-α-methyltyrosine accumulation as a definitive chemoradiotherapy response predictor in patients with esophageal cancer.
Anticancer Res. 2014; 34(2):909-13 [PubMed] Related Publications
AIMS: L-[3-(18)F]-α-Methyltyrosine ((18)F-FAMT) has high specificity for malignant tumors on positron emission tomography (PET), and its role and potential usefulness has been previously investigated in operable esophageal carcinoma. We aimed to assess the ability of (18)F-FAMT PET to predict the response of esophageal cancer to definitive chemoradiotherapy.
PATIENTS AND METHODS: We retrospectively reviewed 40 patients with esophageal cancer imaged with (18)F-FAMT PET. The relationship between (18)F-FAMT PET uptake before chemoradiotherapy and clinical outcomes was assessed.
RESULTS: The primary tumor was visualized in 95% patients. (18)F-FAMT uptake was significantly positively correlated with lymph node metastasis. The low-(18)F-FAMT accumulation group had significantly higher complete response (CR) rates than did the high-accumulation group. The addition of a lymph node metastasis category with low (18)F-FAMT uptake provides a more precise predictor of CR.
CONCLUSION: (18)F-FAMT uptake prior to treatment is a good predictor of CR rate after CRT for esophageal cancer.

Related: Cancer of the Esophagus Esophageal Cancer

Kasashima H, Kubo N, Ohira M, et al.
Successful resection of esophageal carcinoma with aberrant right subclavian artery using video-assisted thoracoscopic surgery: report of two cases.
Anticancer Res. 2014; 34(2):899-904 [PubMed] Related Publications
The right non-recurrent inferior laryngeal nerve (NRILN) is a rare nerve anomaly that communicates the laryngeal nerve to the right vagal nerve trunk directly in the neck, which is usually accompanied by aberrant right subclavian artery (ARSA). We report on two cases of thoracic esophageal carcinoma undertaken in patients with these abnormalities: a 73-year-old woman with progressive dysphagia and a 63-year-old asymptomatic man. Although there have been 10 cases of thoracic esophageal carcinomas associated with ARSA and NRILN in literature, as far as we are aware of, this is the first report to describe successful resection using video-assisted thoracoscopic surgery (VATS). We found that the combination of preoperative recognition of the ARSA using three-dimensional computed tomography (3D-CT) and VATS in the prone position allowed for visual magnification with an excellent thoracoscopic view and facilitated successful tumor resection and preservation of NRILN.

Related: Cancer of the Esophagus Esophageal Cancer

Pontoriero A, Iatì G, Conti A, et al.
Treatment of periocular basal cell carcinoma using an advanced stereotactic device.
Anticancer Res. 2014; 34(2):873-5 [PubMed] Related Publications
Basal cell carcinoma (BCC) is the most common malignant periocular tumor. When periorbital invasion exists, orbital exenteration is necessary. A 73-year-old man with recurrent BCC of the inner canthus of the left eye with diffusion to the extrinsic muscles of the orbit and periorbital fat was treated with CyberKnife in stereotactic body radiation therapy (SBRT) modality. The treatment resulted in rapid tumor regression, with a complete remission after six months without toxicities. To the best of our knowledge, this is the first report in the English literature describing a locally advanced BCC treated with SBRT alone.

Related: Basal Cell Carcinoma

Massaro P, Corbella F, DI Liberto R, et al.
Late oral mucosa alterations after radiotherapy for head and neck cancer assessed by exfoliative cytology.
Anticancer Res. 2014; 34(2):837-44 [PubMed] Related Publications
AIM: Late oral mucosa changes after radiotherapy for head and neck cancer have been poorly studied. This study aimed to determine long-term effects of radiotherapy on oral mucosa using exfoliative oral cytology.
PATIENTS AND METHODS: Fifty patients with cancer were enrolled, five of whom in order to validate microscopic analysis. Smears were collected at programmed visit; a score was used to rank possible cytological alterations. Presence of inflammation was also microscopically described and compared to blood count tests.
RESULTS: Epithelial cells revealed a peculiar 'folding' phenotype, not related to chemotherapy, total dose, or to the effective dose delivered to mucosa. Inflammation described was related to the score for 'folding' cells; moreover, score decreased in the presence of a higher lymphocyte count, while it was not altered by neutrophil count.
CONCLUSION: We suggest application of exfoliative cytology to study radiation injury and the variability of individual response of oral mucosa to radiation.

Kondo S, Mukudai Y, Soga D, et al.
Differential expression of vascular endothelial growth factor in high- and low-metastasis cell lines of salivary gland adenoid cystic carcinoma.
Anticancer Res. 2014; 34(2):671-7 [PubMed] Related Publications
We used high- (ACCM) and low- (ACC2) metastasis cell lines of human adenoid cystic carcinoma (ACC) as an experimental model to study metastatic mechanisms and compare their expression levels for angiogenic-related factor vascular endothelial growth factor (VEGF). By using a series of extensive analyses, hypoxia-inducible factor-1 (HIF-1) α-dependent VEGF expression levels were observed to be higher in ACCM cell lines, increasing the possible development of tumor metastasis, compared to ACC2 cell lines. Our findings provide the novel insight that HIF-1α-dependent VEGF overexpression under hypoxic conditions shows to some extent associations with the metastatic tendency of ACC cells and may function as a potential target for ACC therapy.

Related: HIF1A Salivary Gland Cancer VEGFA

Lee C, Lee C, Lee S, et al.
The cytoplasmic extension of the integrin β6 subunit regulates epithelial-to-mesenchymal transition.
Anticancer Res. 2014; 34(2):659-64 [PubMed] Related Publications
Prognosis for oral cancer patients has not improved in over 60 years due to invasion and recurrence. To understand the invasive behavior of this tumor, we evaluated the role of the αvβ6 integrin. Invasive oral SCC cells express the αvβ6 integrin, which contains an 11-amino-acid extension on its β-subunit unique to the integrin family. We determined that this β6 cytoplasmic extension regulates the composition of the intermediate filament network and the organization of signaling structures called focal contacts. The auto-phosphorylation of FAK, which is localized to focal contacts, was also regulated by the β6-cytoplasmic tail, as were the transcription factors Notch and STAT3. Lastly, we also determined that activation of MAPK required the full-length β6 integrin. Together these results indicate that the signaling critical to epithelial-to-mesenchymal transition (EMT) is regulated by the β6 integrin cytoplasmic domain.

Related: Signal Transduction

DE Lima PO, Jorge CC, Oliveira DT, Pereira MC
Hypoxic condition and prognosis in oral squamous cell carcinoma.
Anticancer Res. 2014; 34(2):605-12 [PubMed] Related Publications
Oral squamous cell carcinomas (OSCCs) have the potential for rapid and unlimited growth. Therefore, hypoxic tissue areas are common in these malignant tumours and contribute to cancer progression, resistance to therapy and poor outcome. Out of all proteins induced by hypoxia, hypoxia-inducible factors (HIFs) and their target genes have been most extensively studied. HIF1 is a heterodimeric transcriptional complex that functions as the main regulator of systemic and cellular oxygen homeostasis; it is composed of HIF1α and HF1β subunits. At physiological concentrations of oxygen, prolyl hydroxylases (PHDs) modify HIF1α and prepare it for proteasomal degradation. In hypoxia, PHDs are inhibited and HIF1α dimerises with HIF1β to form HIF1, which is responsible for the activation of several genes involved in multiple aspects of tumor biology. Among these genes, vascular endothelial growth factor (VEGF) is essential as a regulatory gene of angiogenesis in the adaptation to a hypoxic microenvironment. Previous studies have shown the correlation between HIF1α and VEGF in OSCC and high levels of HIF1α expression appear to predict a poor prognosis. The purpose of the present article is to review the hypoxic condition in OSCC and its correlation with prognosis.

Related: Oral Cancer

Popescu E, Trandafir V, Negru D, et al.
Hemangioma of the parotid gland: case report.
Rev Med Chir Soc Med Nat Iasi. 2013 Jan-Mar; 117(1):227-32 [PubMed] Related Publications
Hemangiomas account for half of the parotid gland tumors occurring in children. After a rapid increase in the first months of life, some of them gradually regress (until complete disappearance) in a period of several years. Hemangiomas that do not regress over time, grow in size (possibly within a short period of time) or develop complications such as intralesional acute bleeding or thrombosis require aggressive therapy: intralesional corticosteroid injection, sclerotherapy. radiation therapy, laser photocoagulation. embolization, or surgical removal. We present the case of a 12-year-old boy with hemangioma of the left parotid gland diagnosed by CT scan, angio-CT with 3D reconstruction and angiography successfully treated by superselective intraarterial embolization with acrylic glue followed after 4 days by left superficial parotidectomy with facial nerve preservation.

Rivis M, Poenaru M, Ionita H, et al.
The MRI fine evaluation of cervical lymphadenopathies and associated oral cavity pathological conditions.
Rev Med Chir Soc Med Nat Iasi. 2013 Jan-Mar; 117(1):217-21 [PubMed] Related Publications
The aim of this paper is to point out the value of MRI in diagnostic assessment of cervical lymphadenopathies and associated oral cavity pathological conditions. We used a statistic retrospective method to evaluate the results obtained after MRI examinations of 64 patients diagnosed with oral cavity pathology and cervical lymphadenopathies. In all cases the MRI exams detected the presence of cervical lymphadenopathies, their topoanatomic sites and oral cavity pathological entities that produced them. Due to fine characterization abilities by internal signal variation. MRI is the method of choice in daily practice for diagnosing, evaluation and staging of oral cavity pathology and cervical lymphadenopathies. Due to fine capacities of detecting internal signal variations in soft tissues or visceral parenchyma, MRI has high abilities in diagnostic assessment of oral cavity pathologies being a daily method of choice for diagnosing, evaluation and staging, with great value in any morbid entity.

Related: Oral Cancer

Wachinger C, Sharp GC, Golland P
Contour-driven regression for label inference in atlas-based segmentation.
Med Image Comput Comput Assist Interv. 2013; 16(Pt 3):211-8 [PubMed] Free Access to Full Article Related Publications
We present a novel method for inferring tissue labels in atlas-based image segmentation using Gaussian process regression. Atlas-based segmentation results in probabilistic label maps that serve as input to our method. We introduce a contour-driven prior distribution over label maps to incorporate image features of the input scan into the label inference problem. The mean function of the Gaussian process posterior distribution yields the MAP estimate of the label map and is used in the subsequent voting. We demonstrate improved segmentation accuracy when our approach is combined with two different patch-based segmentation techniques. We focus on the segmentation of parotid glands in CT scans of patients with head and neck cancer, which is important for radiation therapy planning.

Ali S, Lewis J, Madabhushi A
Spatially aware cell cluster(spACC1) graphs: predicting outcome in oropharyngeal pl6+ tumors.
Med Image Comput Comput Assist Interv. 2013; 16(Pt 1):412-9 [PubMed] Related Publications
Quantitative measurements of spatial arrangement of nuclei in histopathology images for different cancers has been shown to have prognostic value. Traditionally, graph algorithms (with cell/nuclei as node) have been used to characterize the spatial arrangement of these cells. However, these graphs inherently extract only global features of cell or nuclear architecture and, therefore, important information at the local level may be left unexploited. Additionally, since the graph construction does not draw a distinction between nuclei in the stroma or epithelium, the graph edges often traverse the stromal and epithelial regions. In this paper, we present a new spatially aware cell cluster (SpACC1) graph that can efficiently and accurately model local nuclear interactions, separately within the stromal and epithelial regions alone. SpACC1 is built locally on nodes that are defined on groups/clusters of nuclei rather than individual nuclei. Local nodes are connected with edges which have a certain probability of connectedness. The SpACC1 graph allows for exploration of (a) contribution of nuclear arrangement within the stromal and epithelial regions separately and (b) combined contribution of stromal and epithelial nuclear architecture in predicting disease aggressiveness and patient outcome. In a cohort of 160 p16+ oropharyngeal tumors (141 non-progressors and 19 progressors), a support vector machine (SVM) classifier in conjunction with 7 graph features extracted from the SpACC1 graph yielded a mean accuracy of over 90% with PPV of 89.4% in distinguishing between progressors and non-progressors. Our results suggest that (a) stromal nuclear architecture has a role to play in predicting disease aggressiveness and that (b) combining nuclear architectural contributions from the stromal and epithelial regions yields superior prognostic accuracy compared to individual contributions from stroma and epithelium alone.

Related: Oropharyngeal Cancer

Vemuri AS, Nicolau SA, Ayache N, et al.
Inter-operative trajectory registration for endoluminal video synchronization: application to biopsy site re-localization.
Med Image Comput Comput Assist Interv. 2013; 16(Pt 1):372-9 [PubMed] Related Publications
The screening of oesophageal adenocarcinoma involves obtaining biopsies at different regions along the oesophagus. The localization and tracking of these biopsy sites inter-operatively poses a significant challenge for providing targeted treatments. This paper presents a novel framework for providing a guided navigation to the gastro-intestinal specialist for accurate re-positioning of the endoscope at previously targeted sites. Firstly, we explain our approach for the application of electromagnetic tracking in acheiving this objective. Then, we show on three in-vivo porcine interventions that our system can provide accurate guidance information, which was qualitatively evaluated by five experts.

Related: Cancer of the Esophagus Esophageal Cancer

Wang H, Liu J, Jiang C, et al.
Transthoracic esophagectomy using endobronchial blocker after previous pneumonectomy.
Ann Thorac Surg. 2014; 97(2):723-5 [PubMed] Related Publications
Esophagectomy after pneumonectomy is very rare. We present a case of esophagectomy for esophageal cancer after left pneumonectomy. By application of an endobronchial blocker, satisfactory results were achieved and the disadvantages of extracorporeal membrane oxygenation, cardiopulmonary bypass, and other ventilation methods were avoided.

Related: Cancer of the Esophagus Esophageal Cancer

Eliyas S, Porter R, Briggs P, et al.
Effects of radiotherapy to the jaws. 2: Potential solutions.
Eur J Prosthodont Restor Dent. 2013; 21(4):170-81 [PubMed] Related Publications
Dental maintenance and rehabilitation of head and neck cancer care is becoming more important as the outcome of cancer treatment improves. The management of these patients can be very difficult for a number of reasons as discussed in part one of this two-part series. This second part attempts to suggest possible solutions for the management of the major oral health problems encountered by these patients during and after their cancer treatment.

Eliyas S, Porter R, Briggs P, Patel RR
Effects of radiotherapy to the jaws. I: The scale of the problem.
Eur J Prosthodont Restor Dent. 2013; 21(4):161-9 [PubMed] Related Publications
Cancer care has become one of the main targets of the National Health Service in England and with cancer patients surviving longer, it is likely that head and neck cancer patients will make up a large proportion of patients seen within secondary care settings in the future. The management of these patients can be very difficult for a number of reasons. Part one of this paper attempts to highlight the major oral health problems encountered by these patients during and after their cancer treatment and supported by the current literature. Part two of this series will address the dental management of head and neck oncology patients undergoing radiotherapy with particular attention of possible improvement to current management strategies for these patients.

More Y, D'Cruz AK
Oral cancer: review of current management strategies.
Natl Med J India. 2013 May-Jun; 26(3):152-8 [PubMed] Related Publications
BACKGROUND: India has one of the highest incidences of oral cancer and accounts for about 30% of all new cases annually. A high prevalence of smokeless tobacco use has led to an increasing incidence, which in combination with delayed presentation has made oral cancer a major health problem in India. Limited access to cancer care, relative lack of trained healthcare providers and financial resources are some of the challenges to the management of oral cancer in India despite improvements in diagnostic techniques and management strategies.
METHODS: We reviewed the literature pertaining to the epidemiology, aetiopathogenesis, pre-malignancy, tumour progression, management of the primary site, mandible, neck lymph node metastases, reconstruction options and screening of oral cancer. The parameters evaluated were overall survival, disease-free survival, recurrence and loco-regional control.
RESULTS: Nine studies on surgical intervention were reviewed. There were 23 studies on the management of chemotherapy and 30 trials analysing radiotherapy as an intervention.
CONCLUSION: India has one of the highest incidences of oral cancer and delayed stage presentation is common. Surgery remains the treatment of choice and adjuvant treatment is recommended in high-risk patients. Elective neck dissection is warranted in clinically lymph node-negative neck for patients with thick tumours, imaging-suspected lymph nodes and those who may not have a reliable follow-up. Functional outcomes and treatment-related morbidity needs to be considered, and reconstruction with free tissue transfer provides the best results.

Related: Cancer Screening and Early Detection Oral Cancer

Mnif H, Chakroun A, Charfi S, et al.
Primary mucinous carcinoma of the thyroid gland: case report with review of the literature.
Pathologica. 2013; 105(4):128-31 [PubMed] Related Publications
Primary mucinous thyroid carcinoma (PMTC) are extremely rare lesions that are histologically indistinguishable from mucinous carcinoma of other sites. We describe the clinicopathological, histological and immunohistochemical features of this rare tumour with a review of the literature. We describe a case of thyroid tumour, in 56-year-old Tunisian man, composed of small nests and sheets of malignant epithelial cells associated with extensive extracellular mucin that entrapped the follicular parenchyma of thyroid. Thyroglobulin and thyroid-specific-transcription factor 1 (TTFl) were focally positive. Follow-up did not reveal another neoplasm at other sites. Based on these features, we classified this tumour as PMTC. Mucinous carcinoma of the thyroid gland can be a cause of pitfall in differential diagnosis. For correct diagnosis, complete clinical history, restricted histological criteria and immunohistochemical panel are necessary.

Related: Thyroid Cancer

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